Use of the Classic Hallucinogen
Psilocybin for Treatment
of Existential Distress Associated
with Cancer
Charles S. Grob, Anthony P. Bossis,
and Roland R. Griffiths
This chapter will review the potential of a treat-
ment approach that uses psilocybin, a novel psy-
choactive drug, to ameliorate the psychospiritual
distress and demoralization that often accompa-
nies a life-threatening cancer diagnosis. Early
research with classic hallucinogens in the 1950s
had a major impact on the evolving field of psy-
chiatry, contributing to early discoveries of basic
neurotransmitter systems and to significant devel-
opments in clinical psychopharmacology. While
published reports of therapeutic breakthroughs
with difficult to treat and refractory patient popu-
lations were initially met with mainstream profes-
sional enthusiasm, by the late 1960s and early
1970s the growing association of hallucinogens
with widespread indiscriminate use led to the tem-
porary abandonment of this promising psychiatric
treatment model. After a hiatus lasting several
decades, however, regulatory and scientific sup-
port has grown for the resumption of clinical
research investigations exploring the safety and
C.S. Grob, M.D. (*)
Department of Psychiatry,
Harbor-UCLA Medical Center, Box 498
1000W, Carson St., Torrance, CA 90509, USA
e-mail: cgrob@labiomed.org
A.P. Bossis, Ph.D.
Department of Psychiatry, New York University School
of Medicine, New York, NY, USA
R.R. Griffiths, Ph.D.
Departments of Psychiatry and Neuroscience,
Johns Hopkins University School of Medicine,
Baltimore, MD, USA
B.I. Carr and J. Steel (eds.), Psychological Aspects of Cancer,
DOI 10.1007/978-1-4614-4866-2_17, © Springer Science+Business Media, LLC 2013
17
efficacy of a treatment model utilizing the classic
hallucinogen, psilocybin, in a subject population
that had previously demonstrated positive thera-
peutic response, patients with existential anxiety
due to a life-threatening cancer diagnosis.
Psilocybin
Psilocybin is a naturally occurring compound
that is an active constituent of many species of
mushrooms, including the genera Psilocybe,
Conocybe, Gymnopilus, Panaeolus, and
Stropharia. Psilocybin containing mushrooms
grow in various parts of the world, including the
United States and Europe, but until recently they
have been consumed primarily in Mexico and
Central America, where they were called by the
ancient Aztec name of teonanacatl (flesh of the
gods). In addition to psilocybin, other naturally
occurring classic hallucinogens include mesca-
line from peyote and dimethyltryptamine (DMT)
from various plants. All three of these substances
have a long history of ceremonial use by indige-
nous people for religious and healing purposes.
Following the arrival of Europeans in the New
World in the sixteenth and seventeenth centuries,
however, the use of plant hallucinogens by native
people was harshly condemned and punished
under the strict laws of the Spanish Inquisition,
and forced to go underground. This suppression
was so effective that hallucinogenic mushroom
use was eventually assumed to be nonexistent,
until the discovery by amateur mycologist,
291
292
R. Gordon Wasson, of their extant ceremonial use
by indigenous Mazatec people of Oaxaca, in the
central Mexican highlands. Invited to participate
in a healing ritual using mushrooms as a psycho-
active sacrament, Wasson published his observa-
tions in the popular American press in 1957,
catalyzing both popular and professional interest
[65, 85]. Subsequently, the eminent Swiss natural
products chemist, Albert Hofmann, succeeded in
isolating the active tryptamine alkaloid, psilocy-
bin, from samples of the hallucinogenic mush-
rooms from Mexico sent to him by Wasson.
Psilocybin is 4-phosphoryloxy-N,N-dimethyl-
tryptamine and possesses a chemical structure
similar to the neurotransmitter serotonin
(5-hydroxytryptamine). Psilocybin is rapidly
metabolized to psilocin, which is a highly potent
agonist at serotonin 5-HT-2A and 5-HT-2C recep-
tors [79, 80]. Research suggests that the primary
site of action for the psychoactive effects of psi-
locybin is the 5-HT-2A receptor [73, 98]. During
the 1960s psilocybin was subjected to psychop-
harmacological investigation, and found to be
active orally at around 10 mg, with stronger
effects at higher doses, and to have a 4–6-h dura-
tion of experience. Psilocybin was also deter-
mined to be thirty times stronger than mescaline
and approximately 1/100–150 as potent as lyser-
gic acid diethylamide (LSD) [44]. Compared to
LSD, psilocybin was considered to be more
strongly visual, less emotionally intense, more
euphoric, and with fewer panic reactions and less
likelihood of inducing paranoia [78]. Similar to
other classic hallucinogens, psilocybin was
observed to produce an altered state of conscious-
ness that was characterized by changes in percep-
tion, cognition, and mood in the presence of an
otherwise clear sensorium, along with visual illu-
sions and internal visionary experience (though
rarely frank hallucinations), states of ecstasy, dis-
solution of ego boundaries, and the experience of
union with others and with the natural world.
In the late 1990s, psilocybin was subjected to
renewed examination by contemporary investiga-
tors, including Franz Vollenweider and colleagues
at the Heffter Research Center and the University
of Zurich, in Switzerland. Careful medical and
laboratory evaluations conducted there identified
a relatively safe physiological range of action in
C.S. Grob et al.
normal volunteer subjects [36, 94]. Positron
emission tomographic (PET) studies also demon-
strated that psilocybin induces a global increase
in cerebral metabolic rate of glucose, most mark-
edly in the frontomedial and frontolateral cortex,
anterior cingulate and temporomedial cortext
[97]. In another recent study, at the University of
Arizona, Francisco Moreno examined the use of
psilocybin in the treatment of severe, refractory
obsessive-compulsive disorder, observing that
psilocybin appeared to be safe, well tolerated,
and capable of inducing “robust acute reduc-
tions” in OCD symptoms [67]. Further investiga-
tions of psilocybin in normal volunteers were
conducted at the Johns Hopkins University
exploring the emergence of psychospiritual states
of consciousness following psilocybin adminis-
tration [30] (see section below). The Johns
Hopkins group also published a set of recom-
mended guidelines for safe conduct of high-dose
research with classic hallucinogens [47].
Psychiatric Research with Classic
Hallucinogens: Historical Perspective
Hallucinogens consist of a diverse group of
biologically active compounds. Hallucinogens in
plant form are thought to have been utilized by
prehistoric and early civilizations as essential
features of their religious, initiation, and healing
rituals. Ethnobotanists have catalogued more
than one hundred species of plant hallucinogens,
the majority in the Western hemisphere, where
they played a vital role within indigenous cere-
monial practices [91]. In the late nineteenth
Century, interest in psychoactive plants was cata-
lyzed by discoveries of anthropologists studying
native people around the world, who shipped
specimens to leading European pharmacologists
of that era, including Arthur Heffter and Louis
Lewin, who succeeded, respectively, in isolating
mescaline from the southwest American cactus
peyote, Lophophora williamsii, and harmine
from banisteriopsis caapi, one of the plants
brewed to create the Amazonian plant hallucino-
gen decoction, ayahuasca.
The classic hallucinogens can be divided
structurally into two classes of alkaloids: the
17 Use of the Classic Hallucinogen Psilocybin for Treatment of Existential…
tryptamines, including psilocin and psilocybin
(constituents of Psilocybe and several other
mushroom genera), DMT (constituent of the
plant admixture ayahuasca and other hallucino-
genic preparations), and d-LSD, and the pheneth-
ylamines, including mescaline (constituent of
peyote) and various synthetic compounds. The
primary pharmacological effects of these sub-
stances are mediated at 5-HT2A receptors where
they function as agonists. The first classic hallu-
cinogen to be characterized pharmacologically
was mescaline, which was discovered in 1896
and synthesized de novo in the laboratory in 1919
[45]. While some attention was given in the early
twentieth Century to potential medicinal applica-
tions of hallucinogens and there were preliminary
efforts to formally classify and analyze visions
induced by alkaloids discovered in particular
plants [1, 55], widespread medical and psychiat-
ric interest did not emerge until the mid-twentieth
Century, following Albert Hofmann’s serendipi-
tous discovery of LSD at the Sandoz Laboratories
in Basel, Switzerland, in 1943 [40].
From the 1950s, when formal study of the
range of effect of hallucinogens and their poten-
tial in treatment models was initiated, until the
early 1970s, when cultural and political turmoil
led to the termination of studies, over 1,000 clini-
cal and research reports were published in the
medical and psychiatric literature describing the
response to hallucinogen administration of
approximately 40,000 research subjects and
patients [33]. While initial research focused on
the presumed capacity of hallucinogens to induce
psychotic-like experience, interest in this psy-
chotomimetic model waned [2, 32]. By the late
1950s and into the 1960s, however, significant
new research activity was catalyzed by studying
potential treatment applications of hallucinogens,
most notably for several notoriously difficult-
to-treat clinical conditions, including alcoholism,
drug addiction, obsessive-compulsive disorder,
chronic post-traumatic stress disorder, antisocial
disorder, infantile autism, and the overwhelming
existential anxiety often experienced in the pres-
ence of terminal cancer. Two discrete treatment
models were proposed, involving the administra-
tion of lower versus higher dosages of hallucino-
gens and the application of different theoretical
293
mechanisms of action for their observed thera-
peutic effect. The initial treatment structure
investigated, the psycholytic model, called for
the administration of relatively low dosages of
hallucinogens, with the postulated goal of facili-
tating the release of repressed psychic material,
particularly in anxiety states and obsessional
neuroses. Using this approach, some clinicians
claimed to have achieved breakthroughs in reduc-
ing the duration and improving the outcome of
psychotherapeutic treatment, presumably by
facilitating ego regression, uncovering early
childhood memories, and inducing an affective
release [10].
As investigators began to explore the effects
of higher dosages of hallucinogens on clinical
subjects and patients, however, they began to
appreciate that hallucinogens were capable of
occasioning entirely new and novel dimensions
of consciousness. Humphrey Osmond, a Canadian
alcoholism researcher, noted that this high-dose
hallucinogen, or psyche-delic (translated from
the ancient Greek as “mind revealing”) treatment
model, appeared to free up the mind from its
habitual moorings and allow it to access states of
consciousness resembling spontaneous psychos-
piritual epiphanies. Osmond observed that even
after the effects of the administered drug had
worn off, individuals were still left with a deeply
positive and therapeutic impact from having had
a mystical level transcendent experience [74].
With certain conditions in particular, including
alcoholism and other addictive disorders, the
mysticomimetic capacity of the hallucinogen
experience often appeared to have induced remis-
sions from intractable psychological conditions
to a greater degree unique than conventional
treatment modalities. While the low-dose psy-
cholytic model usually involved active discourse
between patient and psychotherapist in the ser-
vice of analyzing underlying neurotic complexes,
the high-dose psychedelic model involved the
development of an alternative treatment structure,
with the subject lying down, wearing eyeshades
and listening to preselected music throughout
much of the session. During the session, the
patient was encouraged to go deeply into the
experience, with the facilitator maintaining an
active presence but generally not engaging in
294
verbal dialogue until the concluding phase of the
treatment session.
One patient population that demonstrated pos-
itive response to the hallucinogen treatment
model were individuals with advanced cancer
with overwhelming anxiety in reaction to their
terminal illness. Beginning with the observations
of internal medicine investigators in the late
1950s at the Chicago Medical School [51, 52]
and UCLA [15], and extending by the mid 1960s
to psychiatrists and psychologists at the University
of Maryland [35, 77, 84] and UCLA [23], a grow-
ing consensus within the field of hallucinogen
investigations was achieved that patients with
advanced-stage cancer treated with this novel
approach frequently sustained significant
improvements of their psychospiritual status.
Moving accounts were reported of patient experi-
ences, including reduced physical pain and less-
ened need for narcotic medication, improved
quality of life, and greater acceptance of the inev-
itable and in some cases imminent end of their
lives. Of particular interest, the most positive
therapeutic outcomes, reflected in lowered anxi-
ety, demoralization, and fear of death, and in
improved mood and quality of meaningful inter-
personal relations, were in patients who during
the course of what was often their only hallucino-
gen treatment session experienced a deeply felt
mystical state of consciousness. Unfortunately,
these promising observations were terminated
prematurely, largely in response to public and
political concern about the misuse of these com-
pounds in the 1960s.
Contemporary Psilocybin Research
in Patients with Life-Threatening Cancer
Following decades of inactivity, it has been pos-
sible in recent years to obtain the regulatory
approval and funding necessary to resurrect this
long neglected treatment model. While improve-
ments in caring for patients at the end of life have
occurred in the intervening years, including the
development of the hospice movement and the
field of palliative medicine, it is still clear that even
with these innovative approaches many individu-
als still go through the final phase of their life with
C.S. Grob et al.
high levels of anxiety, depression, and demoral-
ization. Given the pressing need for more effec-
tive therapeutic interventions in individuals
struggling with cancer and reactive existential cri-
sis, along with the promising preliminary findings
of the hallucinogen treatment model from the pre-
vious generation of research in patients with ter-
minal medical illness, it is not surprising that this
has become a prominent focus for current research
efforts as well. Indeed, in recent years three inves-
tigations have been approved in the United States
that have examined the use of psilocybin treat-
ment for anxiety and demoralization in patients
with a life-threatening cancer diagnosis—at
Harbor-UCLA Medical Center, Johns Hopkins
University, and New York University.
In 2004 the Harbor-UCLA psilocybin
treatment protocol for anxiety in patients with
advanced cancer was initiated. A total of 12
patients were recruited for a double-blind, pla-
cebo-controlled investigation, using a moderate
dose (0.2 mg/kg) of psilocybin. All patients were
screened to meet inclusion and exclusion criteria,
which included a diagnosis of advanced-stage
cancer but still functional enough to undergo full
screening, preparation for the psilocybin ses-
sions, and participation in two all-day sessions
spaced several weeks apart, one active drug and
the other placebo. Support with integration of the
experience and collection of follow-up reports
and quantitative data analyses continued with
each patient for at least 6 months. Recruitment
for all patients into the study, their participation
in both psilocybin and placebo treatment ses-
sions, and collection of data concluded in early
2008. At the time of the writing of this chapter, in
2011, 11 of the 12 participants have died.
The report describing the rationale for the
investigation, methodology employed, and
findings up to 6 months after treatment was pub-
lished in the Archives of General Psychiatry
[34]. All patients tolerated the psilocybin expe-
rience well, and there were no medical or psy-
chological crises. Repeated administration of
quantitative rating scales revealed improved
mood and lessened anxiety, reaching significance
at some monthly data collection points. Overall,
patients reported their participation in the psilo-
cybin treatment as having been a very valuable
17 Use of the Classic Hallucinogen Psilocybin for Treatment of Existential…
experience, allowing them to improve their quality
of life and augmenting their capacity to withstand
the psychological stressors of their medical con-
dition. While the Harbor-UCLA research investi-
gation has been completed, both the Johns
Hopkins and NYU projects are currently ongo-
ing. The Johns Hopkins and NYU studies, initi-
ated in 2006 and 2009, respectively, both approved
to use a significantly higher dose than the Harbor-
UCLA protocol, which will likely allow for more
exploration of the psychospiritual dimension of
the experience. These studies also offer more
flexibility for subject inclusion, and allow for the
entry of early-stage cancers that are nonetheless
considered potentially life threatening. It is
strongly hoped that additional research groups
will also initiate treatment protocols exploring
the utility of the psilocybin treatment model with
medical patients encountering existential crisis
and demoralization at the end of life.
Comments from Annie L, a 53-year-old
woman with a diagnosis of metastatic ovarian
cancer, 6 months after her participation in a
Harbor-UCLA psilocybin cancer-anxiety study:
“I had lost my faith because of anxiety, and I was
just terrified. I was so anxious that it was hard to
think about anything else. I didn’t think I was so
worried about death as I was about the process of
dying. About suffering and being in pain and hav-
ing all kinds of medical procedures. I was becom-
ing so irritable with my husband. I was just so
anxious… My intention (for participation in the
study) was to be able to control my anxiety so
295
I could enjoy the rest of my life. I was not enjoying
my life at all.
As soon as it (the psilocybin) started working
I knew I had nothing to be afraid of… It connected
me with the universe… It was very gentle… And
there were people (the treatment team) right there
if I got upset… Everything looked absolutely beau-
tiful. I didn’t see things that weren’t there. With my
eyes closed I saw patterns, and visions and faces.
I thought about being involved with people I loved,
things I would do with people I knew, things
I would tell them… I had an amazing spiritual
experience. It re-connected me to the universe.
Comments from her husband 4 months after
her death:
“Annie’s mood remained greatly improved for
some time after the treatment. She also had much
less anxiety, and her fear of getting sicker and her
fear of the dying process also diminished a great
deal. Beyond that, she and I got along much better
after her psilocybin treatment … I have no doubt
that the treatment Annie went through was of great
value to her …”
Overview and Prevalence
of Emotional Distress in Advanced
Cancer
For many cancer patients, the advanced stage of
illness is fraught with a significant degree of emo-
tional suffering. As the illness trajectory pro-
gresses from diagnosis through medical treatment
and eventually to the prospect of dying, the patient
may be faced with considerable psychological
distress and despair. In recent years, there has
been a growing focus on the prevalence and clini-
cal treatment of psychological distress in patients
with advanced cancer that are facing the end of
life [20, 48, 50, 57, 86]. Emotional suffering in
advanced illness has been characterized as “severe
distress associated with events that threaten the
intactness of the person” ([9], p. 640).
The occurrence of psychological distress in
cancer patients has been well documented with
the highest prevalence rates among advanced
cancer and end-of-life patients. While some can-
cer patients may cope effectively with the chal-
lenges of the disease, others experience a broad
range of psychological stressors and symptoms.
The prevalence of psychiatric disorders in cancer
patients has been reported at approximately 50 %
296
[17, 61, 71] with the presence of any depressive
or anxiety disorder at 24 % [102]. The prevalence
of major depression has been reported at 15 %
[41, 42, 101] with a range of all depressive disor-
ders in cancer patients at 20 [102] to 26 % [19, 27].
Anxiety spectrum disorders have been docu-
mented at 14 % [102] with the prevalence of any
anxiety symptoms at 21 % [17]. The prevalence
of suicide in advanced and end-stage cancer is
twice as high as that found in the general popula-
tion [11] and an increased desire for hastened
death in terminal patients has been established
[5]. Kelly and colleagues [53] found that 22 % of
advanced cancer patients had a desire for has-
tened death.
Focus on Spiritual and Existential
Distress in Palliative Care
With a growing awareness of emotional suffering
at the end of life, palliative care has increasingly
focused on the specific domain of spiritual and
existential distress as a significant component of
quality of life in cancer and end-of-life cancer
patients [16, 20, 66, 70, 88]. In palliative care,
outcomes are no longer focused solely on bio-
medical or physical measures such as tumor or
disease progression, but have expanded to include
quality of life, now considered a central focus.
Spiritual and existential factors are currently
regarded as determinants of quality of life in
advanced cancer and end-of-life patients. Distress
in cancer and palliative care patients is viewed as
a “multifactorial unpleasant emotional experience
of a psychological, social, and/or spiritual nature”
that impacts patients’ capacity to effectively cope
with the myriad challenges of cancer [71].
Existential or spiritual pain of terminal cancer
patients has been defined as “the extinction of the
being and meaning of the self due to the approach
of death. It can be explained as meaninglessness of
life, loss of identity, and worthlessness of living
that are derived from deprivation of the future, oth-
ers, and autonomy of people as beings founded on
temporality, beings in relationship, and beings with
autonomy” [69]. An individual’s search for spiri-
tual and existential meaning is frequently triggered
by a diagnosis of cancer.
C.S. Grob et al.
The alleviation of spiritual and existential
distress is a primary objective of palliative and end-
of-life care. A report by the Institute of Medicine
listed spiritual well-being as an essential influence
on quality of life and one of the six domains of
quality supportive care of the dying [22]. Similarly,
a report by the Consensus Conference in associa-
tion with the National Consensus Project for
Quality Palliative Care identified spiritual and
existential issues as two of the eight core essential
domains of quality palliative care [81]. The World
Health Organization describes palliative care as
“an approach that improves the quality of life of
patients and their families facing the problems
associated with life-threatening illness, through
the prevention and relief of suffering by means of
early identification and impeccable assessment and
treatment of pain and other problems, physical,
psychosocial and spiritual” [103].
Religion vs. Spirituality
Despite the overlap and ambiguity that have
existed between the concepts of religion and spir-
ituality, a consensus in the research literature has
begun to emerge regarding the distinction
between these two research constructs. Religion
has been defined as structured belief systems that
address universal questions and may provide a
framework for making sense of ultimate ques-
tions of meaning and for expressing spirituality
[93]. Spirituality tends to be a broader, more
inclusive category than religion. It can be defined
as “that which allows a person to experience tran-
scendent meaning in life” [82] and “a personal
search for meaning and purpose in life, which
may or may not be related to religion” [95].
Whereas religion may be commonly viewed
as a structured framework of beliefs and rituals
that may include an expression of spirituality,
spirituality may be experienced without the con-
text of an organized religious system as a search
for transcendence, meaning, and connection to
ultimate meaning, nature, or to how an individual
defines or experiences the concept of God. The
Report of the Consensus Conference on spiritual-
ity in palliative care suggested the following
definition (National Consensus Panel Report):
17 Use of the Classic Hallucinogen Psilocybin for Treatment of Existential…
Spirituality is the aspect of humanity that refers
to the way individuals seek and express meaning
and purpose and the way they experience their
connectedness to the moment, to self, to others,
to nature, and to the significant or sacred [81].
Spiritual Well-Being and Psychological
Distress
The domain of spiritual and existential well-being
is now widely accepted as an important determi-
nant in the quality of life in palliative care and
end-stage cancer [16, 21, 39, 60, 66, 92]. Coping
with terminal cancer is a multifactorial and vari-
able process. Enhanced spiritual well-being and
the ability to attain meaning when facing end-
stage cancer appears to be a key factor in effec-
tively coping with advanced disease. Psychosocial
factors in advanced cancer associated with height-
ened existential and spiritual distress include anxi-
ety and depression [26, 72], anger, alienation,
hopelessness, loss of meaning, loss of dignity, vul-
nerability, isolation, fear, and shock [39, 99, 100].
Chochinov and colleagues [12] identified specific
psychosocial correlates of spiritual and existential
suffering in advanced cancer patients that include
loss of will to live, loss of a sense of dignity,
hopelessness, and feeling as a burden to others.
Impaired spiritual well-being has also been
associated with a poorer tolerance of physical
symptoms whereas an enhanced sense of meaning
and spirituality has been shown to increase an indi-
vidual’s tolerance levels for physical symptoms
[3]. Myriad health care domains and outcomes
have been associated with existential distress
including quality of life, symptom and disease pro-
gression, psychological distress, depression [86],
interpersonal functioning [16, 102], suicidal ide-
ation [63], and demoralization syndrome, defined
as “a psychiatric state in which hopelessness, help-
lessness, meaningless, and existential distress are
the core phenomena” (p. 13. [54]).
Demoralization is defined by Kissane et al.
[54] as a syndrome characterized by hopeless-
ness, loss of meaning, and existential distress.
This syndrome, which is delineated as a separate
construct, has been identified as a primary risk
297
factor for depression in advanced cancer patients.
A desire for hastened death in advanced cancer
patients has also been identified with this syn-
drome. Observed in palliative care and advanced
cancer populations, this syndrome is associated
with chronic medical illness, fear of loss of dig-
nity, social isolation, and the sense of being a
burden on others [54]. Kissane and colleagues
propose that for targeted psychotherapies or
interventions to be effective, they must aim to
explore and restore meaning and hope within the
context of advancing disease and impending
death.
A desire for hastened death has been associ-
ated with lower levels of spiritual well-being
[4, 86, 87]. A growing number of studies have
presented evidence supporting a model that
depression and hopelessness are chief determi-
nants and predictors of a desire for hastened death
(Rodin et al., 2008; [5, 48]). For example, in a
study exploring the relationships among depres-
sion, hopelessness, and desire for hastened death,
Breitbart and colleagues [5] identified depression
as a robust predictor of desire for hastened death.
In this study, patients with major depression were
four times more likely to have a desire for has-
tened death.
Enhanced Spiritual Well-Being as a
Buffer Against Emotional Distress
While there has been a documented relationship
between lack of spiritual well-being and elevated
psychosocial distress, there is increasing evi-
dence to support the hypothesis that enhanced
spiritual or existential well-being is associated
with improved psychological functioning and
might even prove to be a buffer against psycho-
logical syndromes associated with the end of life.
Exploring the relationship between spiritual well-
being, depression, and psychological distress in
end-of-life cancer patients, a growing body of
research has shown that higher levels of spiritual
well-being are correlated with lower levels of
emotional distress and serve as a buffer against
depression, desire for hastened death, loss of will
to live, and hopelessness as well as provide an
298
increase in quality of life [5, 21, 50, 63, 72].
Individuals with an enhanced sense of spiritual
well-being are also emotionally equipped to cope
more effectively with the physical challenges of
advanced and end-stage cancer [3].
The concept of meaning has received consid-
erable attention in palliative care and psycho-
oncology research as an important construct
related to improved quality of life. Cultivating a
sense of meaning in advanced cancer has been
shown to improve spiritual well-being and overall
quality of life while reducing levels of psycho-
logical distress [60, 64, 68]. For some patients,
the search for meaning in end-of-life cancer,
while a psychologically and spiritually complex,
arduous, and courageous process, may provide
them with a sense of peace and acceptance. Viktor
Frankl, in Man’s Search for Meaning, wrote that
“man is not destroyed by suffering; he is destroyed
by suffering without meaning” ([24], p. 135).
Although not written about the end-of-life strug-
gle with cancer or life-threatening disease,
Frankl’s landmark book was written from his per-
sonal experience of survival during his 3 years in
Auschwitz and other concentration camps. His
struggle to derive personal meaning in the face of
horror and death has resulted in universal life les-
sons for those facing severe suffering or existen-
tial distress. In The Will to Meaning: Foundations
and Applications of Logotherapy [25], Frankl
wrote, “Meaning can be found in life literally up
to the last moment, up to the last breath, in the
face of death” (p. 76).
Meaning-enhancing interventions have been
demonstrated to improve quality of life in pallia-
tive care and decrease wishes for euthanasia and
for hastened death [6, 102]. Dame Cicely
Saunders, who gave rise to the hospice move-
ment and emphasized spiritual and psychological
factors in palliative and hospice care, introduced
the concept of “total pain” of the terminal patient
that emphasizes psychospiritual as well as physi-
cal aspects of care and distress. Influenced by
Frankl, she believed that the “total pain” of the
terminal patient was related to a “lack of mean-
ing” [89, 90]. In a quantitative thematic analysis
[96] of all published literature on spirituality in pal-
liative care, the most cited themes were meaning
C.S. Grob et al.
and purpose followed by self-transcendence and
transcendence.
With an increasing body of evidence [5, 50,
63, 72] supporting the premise that enhanced
spiritual well-being provides protection against
depression, hopelessness, and desire for hastened
death among other psychosocial forms of suffer-
ing, there is growing interest in interventions that
enhance or improve psychological well-being
and provide meaning in terminal patients. In
recent years, there have been published reviews
of interventions targeted at improving end-of-life
psychological well-being and reducing various
aspects of psychiatric distress [13, 38, 58, 92].
Interventions aimed at enhanced spiritual well-
being, meaning, and dignity in advanced cancer
patients are now being developed and studied for
effectiveness [6, 14, 38].
Despite the growing awareness of spiritual
and existential distress among end-of-life can-
cer patients and the impact on quality of life,
there remains a paucity of psychotherapeutic
approaches and interventions to directly address
this suffering. In a study evaluating spiritual and
existential needs among cancer patients, Moadel
and colleagues [66] found that from 21 to 51 %
of patients reported unmet spiritual or existen-
tial needs. The unmet spiritual or existential
needs cited by patients were overcoming fears
(51 %), finding hope (42 %), finding meaning in
life (40 %), and finding spiritual resources
(39 %).
Breitbart (2010) [6] notes that while some
interventions are aimed at improved mood, none
examine the effect of spiritual well-being and few
interventional studies are directed at advanced or
end-stage cancer patients. Furthermore, aside
from hallucinogen-induced mystical experience
(discussed below), none provide the means for a
direct intensive alteration in consciousness with
the potential for a transformative experience
directly related to the sacred or to broad spiritual
and existential phenomena. Blinderman and
Cherny [7] note, “It has been observed that exis-
tential distress is the least studied domain of
patient distress. Given the paucity of research in
this area, additional qualitative and quantitative
studies are needed to help further understand this
17 Use of the Classic Hallucinogen Psilocybin for Treatment of Existential…
domain of suffering and the possible areas
of intervention by health care professionals”
(p. 380). Lethborg et al. [59] suggest that “the
specific techniques most effective in enhancing
meaning and connection (in advanced cancer) are
yet to be defined, and such clarification would
require intervention-focused research that, in
order to appropriately demonstrate change, would
need to be longitudinal” (p. 387).
Uniqueness of Psilocybin Mystical
Experience Treatment Model
The hallucinogen treatment model, which has
been shown to generate a mystical or spiritual
experience [30], offers a highly unique and novel
therapeutic approach to promote transcendence,
meaning, and reduction in anxiety for terminal
cancer patients [34]. It is the only approach with
the dying of its kind in medicine, psychiatry, and
the behavioral sciences. Reviews of the literature
on the importance of spirituality in end-of-life
suffering [83, 96] identify transcendence and
meaning as the most common factors. Of the few
spiritual well-being-enhancing interventions for
end-of-life patients currently available, the hal-
lucinogen treatment model is the only approach
that potentially facilitates a radical shift in con-
sciousness yielding a transpersonal, transcendent,
spiritual, and mystical experience.
Access to the transpersonal and transcendent
non-ordinary dimensions of consciousness is an
integral aspect of the enhanced spiritual well-
being generated by the hallucinogen-induced
mystical experience. Eric Cassell, the distin-
guished internist who has contributed consider-
ably to the conversation on dying in America and
who has written extensively about the nature of
suffering, medicine, and the compassionate and
ethical treatment of the terminally ill, writes in his
classic article The Nature of Suffering and The
Goals of Medicine, “Transcendence is probably
the most powerful way in which one is restored to
wholeness after an injury to personhood. When
experienced, transcendence locates the person in a
far larger landscape. The suffering is not isolated
by pain but is brought closer to a transpersonal
299
source of meaning and to the human community
that shares those meanings. Such an experience
need not involve religion in any formal sense;
however, in its transpersonal dimension, it is
deeply spiritual” [9]. Meaning and transcendence,
Cassell suggests, provide unique avenues for the
amelioration of suffering at the end of life.
Access to the transpersonal realm has
the potential to alter a terminal cancer patient’s
perspective to his or her existential suffering.
Transpersonal psychology “is concerned with the
study of humanity’s highest potential, and with
the recognition, understanding, and realization of
unitive, spiritual, and transcendent states of con-
sciousness” (p. 91, [56]). For Aldous Huxley
[43], the British writer who dedicated attention to
comparative spirituality and to the application of
hallucinogens in the dying, the hallucinogen-
induced mystical experience may reveal the indi-
vidual to the “perennial philosophy.” This
philosophia perennis is the philosophical concept
which states that all the world’s religions and
philosophical traditions share a single truth.
Mystical, numinous, and peak states of con-
sciousness have been written about extensively
throughout history by observers and investigators
of philosophy, religion, and consciousness includ-
ing Carl Jung [49], Abraham Maslow [62],
Rudolph Otto [75], William James [46], and
Richard Bucke [8], and appear within the canon
of the major religious and wisdom traditions.
For many cancer patients, the mystical experi-
ence of consciousness provides a profound onto-
logical shift. This ontological or paradigm shift
in awareness has the capability to alter and trans-
form a cancer patient’s assumptions and beliefs
regarding the nature of being, the self, the body,
disease, and death itself. Often, for the patient
who has had this awareness, the body and cancer
are experienced as separate (i.e., “I am not my
cancer”). The self-experience or self-image of
the patient may be recalibrated into a broader
existential view where the meaning of cancer and
even death itself may be transformed and may no
longer be a profoundly anxiety-provoking experi-
ence as it was before. The terror of death may be
altered as an individual experiences connection
to the transpersonal realm, to others, to nature
300
Table 17.1 Phenomenological features of a mystical
type experience—either naturally occurring or occasioned
by a classical hallucinogen
• Unity: A core feature—a strong sense of the
interconnectedness of all people and things—All is
one—sometimes a sense of pure consciousness or a
sense all things are alive
• Sacredness: Reverence, awe, or holiness
• Noetic quality: A sense of encountering ultimate
reality
• Transcendence of time and space: A sense of
timelessness, when past and future collapse into the
present moment—an infinite realm with no space
boundaries
• Deeply felt positive mood: Universal love, joy, peace,
tranquility
• Ineffability and paradoxicality: A sense that the
experience cannot be adequately described in
words—a sense of the reconciliation of paradoxes
itself, or to the sacred. Often, the patient may
experience consciousness as continuing
indefinitely, thereby dramatically modifying or
transforming the concept of death of the self.
The primary characteristics of a mystical
experience, which are summarized in Table 17.1,
appear directly related to the potential for a reduc-
tion in existential and psychospiritual distress.
The potential primary effects or benefits of mysti-
cal or peak consciousness states in cancer patients
are (1) improved psychological, spiritual, and
existential well-being; (2) ability to cognitively or
emotionally reframe the impact of cancer, dying,
and death; (3) increased capacity for appreciation
of time living; (4) increased appreciation and
experience of connectedness to sacredness, nature,
relationships, and family; (5) ability to attend to
unfinished business; (6) the possibility to concep-
tualize death as “not the end” but a transition of
some manner in continuing consciousness; (7)
increased sense of meaning and purpose; and (8)
increased acceptance and peace with death.
Johns Hopkins Studies of Psilocybin-
Occasioned Mystical Type Experience
Building on observations made in a study con-
ducted in early 1960s in seminary students at
Harvard [18, 76], two recent double-blind studies
C.S. Grob et al.
conducted at Johns Hopkins [29–31] have demon-
strated that under carefully controlled conditions,
high doses of psilocybin occasion profound
personally and spiritually meaningful experiences
in the majority of healthy, normal healthy partici-
pants. One study [30, 31] involved 36 volunteers
who participated in 2 or 3 day-long sessions dur-
ing which they received, on separate sessions, a
high dose of psilocybin (30 mg/70 kg) or a dose of
methylphenidate hydrochloride. The design of the
study effectively obscured to volunteers and study
staff who monitored the sessions exactly what
drug conditions were being tested. A subsequent
study [29] involved 18 participants who received,
in mixed order, a range of psilocybin doses (pla-
cebo, 5, 10, 20, and 30 mg/70 kg) over five ses-
sions. The participants in both studies had a mean
age of 46 years and were well educated and high
functioning. All but one was hallucinogen naïve.
Study monitors met individually with each partici-
pant for a total of 8 h before the first session and
for 2 h between sessions to help develop rapport
and trust, which are believed to minimize the risk
of adverse reactions to classic hallucinogens. The
8-h drug sessions were conducted in an aesthetic
living room-like environment designed specifically
for the study (Fig. 17.1). Two monitors were pres-
ent throughout the session. For most of the time
during the session, participants were encouraged
to lie on the couch and use an eye mask and head-
phones. Participants were encouraged to focus
their attention on their inner experiences through-
out the session. Details and rationale for screen-
ing, preparing volunteers, and managing sessions
and aftercare were similar to those described by
Johnson et al. [47].
As expected, psilocybin produced increases in
measures previously shown to be sensitive to hal-
lucinogenic drugs, including perceptual changes
(e.g., visual illusions), greater emotionality (e.g.,
increased joy and peacefulness and, less fre-
quently, fear and anxiety), and cognitive changes
(e.g., changes in a sense of meaning, sometimes
suspiciousness). But perhaps the most interesting
effect was that psilocybin produced large increases
on extensively studied, well-validated question-
naires that were designed to measure naturally
occurring mystical type experiences as described
17 Use of the Classic Hallucinogen Psilocybin for Treatment of Existential…
Fig. 17.1 The living room-like session room used in the
Johns Hopkins psilocybin research studies. Comfortable,
aesthetic environments free of unnecessary medical or
research equipment, in combination with careful volun-
teer screening, volunteer preparation, and interpersonal
support from two or more trained monitors, help to mini-
Fig. 17.2 Post-session ratings on a questionnaire
designed to assess mystical experience. Psilocybin pro-
duced orderly dose-related increases, with most partici-
pants fulfilling the criteria for having had a “complete”
mystical experience (data from [29])
by mystics and religious figures worldwide
and throughout the ages, including measures not
previously used to assess changes after a drug
experience. Figure 17.2 shows that psilocybin
produced orderly dose-related increases in a mea-
301
mize the probability of acute psychological distress dur-
ing sessions. The use of eyeshades and headphones
(through which supportive music is played) may contrib-
ute to safety by reducing distractions as well as social
pressure to verbally interact with research personnel
(reprinted from [47])
sure of mystical experience obtained at the end
of the session day [29]. “Complete” mystical
experiences were those in which volunteers met a
priori criteria on all six phenomenological dimen-
sions of the mystical experience (Table 17.1). The
percentage of volunteers who fulfilled criteria for
having had a “complete” mystical experience was
an increasing function of dose: 0 %, 5.6 %, 11.1 %,
44.4 %, and 55.6 % at 0 mg/70 kg, 5 mg/70 kg,
10 mg/70 kg, 20 mg/70 kg, and 30 mg/70 kg,
respectively. Seventy-two percent of volunteers
had “complete” mystical experiences at either or
both the 20 and 30 mg/70 kg session. On retro-
spective questionnaires completed 1 or 2 months
after the psilocybin session and 14 months after
the last session, volunteers reported sustained
positive changes in attitudes, mood, altruism,
behavior, and life satisfaction. Figure 17.3 shows
that most participants considered the experience
to be among the five most spiritually significant
experiences of their lives, including single most.
Participants also endorsed various domains of
change that suggest increased self-efficacy (e.g.,
increased self-confidence and sense of inner
302
Fig. 17.3 Retrospective ratings of the spiritual
significance of the psilocybin experience 1 month after
sessions. Not shown, at 14 months after the last session,
94 % of participants rated the experience during the 20
and/or 30 mg/70 kg sessions to be among the top five most
spiritually significant experiences of their lives, including
single most (data from [29])
authority) and decreased perceived stress (e.g.,
decreased nervousness, increased inner peace,
and ability to tolerate frustration). Ratings of the
volunteers’ behavior by community observers
(friends, family members, colleagues at work)
who were blind to drug condition were consistent
with the volunteer self-ratings, indicating that the
changes were real rather than imagined.
Of further relevance to the use of psilocybin in
palliative treatment of existential anxiety associ-
ated with terminal illness, Griffiths et al. [29] also
showed that the religious subscale of the Death
Transcendence Scale was significantly increased
over screening levels at both 1- and 14-month
follow-up. This is notable, because questions on
this scale assess a sense of continuity after death
(i.e., Death is never just an ending but part of a
process; Death is a transition to something even
greater in this life; My death does not end my
personal existence; I believe in life after death;
There is a Force or Power that controls and gives
meaning to both life and death).
C.S. Grob et al.
Clinical Case Vignette of a Patient
in an Ongoing Psilocybin
Cancer-Anxiety Study
Roy is a 53-year-old white, American-born male.
He is married, has no children, and is a college
graduate. Roy is a warm, well-related, highly
intelligent man with no psychiatric history or
mental status alterations aside from existential
distress, anxiety, and depressive affects associ-
ated with living with cancer. Both his parents are
deceased, his father of cancer. Roy’s sister-in-law
died of cancer. He reports a fulfilling and very
happy relationship with his wife that was evident
when they were together in the preliminary
research meetings. He cited that one of the pri-
mary sources of emotional distress in contem-
plating the progression and possibility of
eventually dying of cancer is losing time and a
future with his wife. In August 2007, Roy was
diagnosed with cholangiocarcinoma, a cancer of
the bile ducts involving malignant growths in the
ducts that carries bile from the liver to the small
intestine. In September of that same year, he
underwent a partial Whipple and liver resection.
His gallbladder, major bile ducts, parts of the
duodenum and pancreas, and the right lobe of his
liver were removed. Surgery was followed by
6 months of chemotherapy. In November 2008, a
CT scan showed metastasis to the lungs.
Since February 2009, chemotherapy was
implemented biweekly. He reported that this
biweekly intensive chemotherapy had been
extraordinarily difficult causing extreme fatigue,
cognitive “cloudiness,” pain, overall body aches,
discomfort, and psychological distress. He
required assistance during weeks when chemo-
therapy was administered. He has chemotherapy-
induced neuropathy in the hands and feet. After
3 years of contending with the physical and psy-
chological effects of cancer along with the debili-
tating effects of chemotherapy, Roy had grown
increasingly anxious and depressed at which
point he inquired about the psilocybin research
study at New York University School of Medicine
and Bluestone Center for Clinical Research.
17 Use of the Classic Hallucinogen Psilocybin for Treatment of Existential…
The patient had two research study sessions,
one with psilocybin and the other with placebo.
Both the patient and the study monitors were
blinded to the study drug administration. During
one of the experimental study sessions, presum-
ably the psilocybin session, Roy swallowed the
capsule and sat on the couch listening to soft
classical music and viewing picture books with
images of nature. Two clinical researchers, male
and female, were present throughout the session.
Thirty minutes after taking the capsule, the
patient was encouraged to lie down on a couch
prepared like a bed with sheets, pillows, and
blankets. Throughout the session, it was recom-
mended that the patient wear eyeshades and
headphones. The music played was mostly clas-
sical and instrumental. The room replicates a
warm and nicely furnished living area with paint-
ings, Asian area rug, soft lighting, flowers, books,
and personal items from the patient.
At 2 h post ingestion and following a period of
silence, the patient stated, “Birth and death is a lot
or work” repeating it twice and began to cry softly.
Over the course of the session, which lasted
approximately 6 h, Roy alternated between crying
softly, smiling, and laughing. For long periods of
time, he lay completely still and silent sometimes
uttering short sentences, sometimes with a look of
awe on his face. During a 2-h period while lying
completely still he stated, “it’s really so simple, it’s
really so simple.” All this occurred with eyeshades
and headphones on and only with minimal interac-
tion from the monitors. Statements that Roy made
during those 2 h which when compared to his writ-
ten journal and post-session interviews suggest
that he had a “complete” mystical experience by
fulfilling all of the major criteria for such an expe-
rience (see Table 17.1). He later said to the moni-
tors that, during this period, he experienced himself
as completely safe—the safest he had ever felt—
and he had an intense experience of maximal love.
He indicated that he experienced existence or con-
sciousness as continuing infinitely and it was all
filled with love, it was love, there was neither
death nor a beginning. He reported that these
insights and experience gave him enormous com-
fort and meaning. He appeared at complete peace,
but as if engaged in an active internal scene.
303
Approximately 5 h after he took the capsule,
he sat up as the experience began to wane in its
intensity. He reported that the experience was
“life changing” and he was motivated to live more
fully in the present moment. He repeated that the
message was “so simple, it is love, it’s all about
the purity of love, energy of love.” He felt as if his
cancer and the prospect of dying lost significance
with this new “knowledge” or awareness. He
stated that he experienced love that was of inde-
scribable intensity—“like nothing I’ve experi-
enced here.” At one point during the experience,
he reported, “I went into my lungs and saw two
spots” (referring to the nodules identified by med-
ical imaging), and said he felt “they were no big
deal,” that the “cancer is not important, the impor-
tant stuff is love.” He continued to discuss his
newfound perspective on cancer that grew from
the experience stating, “cancer is nothing to fear,”
and “cancer wasn’t very important.” He stated the
most important “ingredient” in life is “the purity
and simplicity of love.” His wife rejoined him in
the session room. They hugged, cried, and the
patient stated to her, “‘It was amazing, amazing, I
saw, I touched … the face of God.”
Roy has continued to report and present with
sustained and marked positive changes in atti-
tude, coping, and mood 18 weeks after the ses-
sion. He has characterized this experience as the
most important life experience he has had second
only to his marriage. Despite his cancer and
uncertain future, he remarked, “I am the luckiest
man on earth” and that “my quality of life is dra-
matically improved.” He has begun a meditation
practice since this experience. He stated that “I
experienced infinity that lasts forever and that is
love” and that this insight and awareness have
stayed with him and shaped his attitude towards
others, his wife, his disease, and the world.
Despite the continuing difficult chemotherapy
schedule and struggling with sickness for days at
a time and additional surgical procedures, he is
coping in a highly effective manner. He still feels
that “the cancer is irrelevant” within the context
of his new awareness, although he remains highly
committed and involved in his medical treatments
and decisions. Weeks after the session he stated
that “this is the best I’ve felt in years” and that he
304
felt “the happiest in his life.” While realistic about
his diagnosis and prognosis, he remains commit-
ted to cultivating a positive attitude and has been
able to remain emotionally connected to the
imagery and existential insights of the psilocybin
research session. In the end, he states that the
overwhelming message was that of “love, warmth,
acceptance” and connection to something greater,
eternal, and sacred. The experience of transcen-
dence and the cultivation of meaning appear to be
the primary factors contributing to his insight, to
the awareness drawn from the session, and to his
coping with the existential and spiritual chal-
lenges of cancer.
The following are excerpts from a journal
entry the patient wrote on the evening and in the
days following his experience:
From here on love was the only consideration.
Everything that happened, anything and everything
that was seen or heard centered on love. It was and
is the only purpose. Love seemed to emanate from
a single point of light … It was so pure. The sheer
joy … the bliss was indescribable. And in fact
there are no words to accurately capture my experi-
ence … my state … this place. I know I’ve had no
earthly pleasure that’s ever come close to this feel-
ing … no sensation, no image of beauty, nothing
during my time on earth has felt as pure and joyful
and glorious as the height of this journey … I felt
very warm but pleasantly so …
I was beginning to wonder if man spent too
much time and effort at things unimportant … try-
ing to accomplish so much … when really, it was
all so simple. No matter the subject, it all came
down to the same thing. Love. Earthly matters such
as food, music, architecture, anything, everything
… aside from love, seemed silly and trivial. I was
convinced in that moment that I had figured it all
out (or it was figured out for me) … it was right
there in front of me … love … the only thing that
mattered. This was now to be my life’s cause.
I announced, “OK, I get it! You can all punch out
now … our work is done!” But quickly I realized
that no … our work … our existence … our energy
… is never done … it goes on and on without end.
I thought about my cancer ….I took a tour of
my lungs. I could see some things but it was more
a matter of feeling the inside of my lungs. I remem-
ber breathing deeply to help facilitate the “seeing.”
There were nodules but they seemed rather unim-
portant … I was being told (without words) to not
worry about the cancer … it’s minor in the scheme
of things … simply an imperfection of your human-
ity and that the more important matter … the real
work to be done is before you. Again love.
C.S. Grob et al.
[On the day after the experience] …I felt spec-
tacular … both physically and mentally! It had
been a very long time since I’d felt that good … a
serene sense of balance … a level of contented-
ness, peace and happiness that lasted all day and
into the evening. Undoubtedly, my life has changed
in ways I may never fully comprehend. But I now
have an understanding … an awareness that goes
beyond intellect … that my life, that every life, and
all that is the universe, equals one thing … love.
Conclusion: Psilocybin Treatment
Implications for Palliative Care
and Psycho-Oncology
While living with advanced cancer may for some
patients be a process of depression, despair, and
increased distress, for others it can provide an
opportunity for personal meaning, enhanced
interpersonal relationships, spiritual growth, clar-
ity, and acceptance. Frequently, a life-threatening
cancer triggers a search for meaning and tran-
scendence and an awakening of spirituality.
A growing body of literature now substantiates the
importance and relevance of spiritual well-being
and spirituality in palliative and hospice care. For
many patients, the search for meaning that is fre-
quently triggered by end-of-life-stage cancer is a
courageous and difficult journey. Ideally, dying
should be viewed, not as a medical problem, but as
an important and vital part of life experience with
potential for discovery and meaning.
Researchers from several decades ago reported
encouraging results from their early efforts devel-
oping a hallucinogen treatment model with
patients suffering from the psychospiritual dis-
tress and demoralization often associated with
advanced-stage cancer. More recent efforts to
reexplore the judicious application of hallucino-
gen treatment with patients struggling with exis-
tential anxiety in the face of a life-threatening
cancer diagnosis have similarly observed
significant amelioration of psychological suffer-
ing. While valuable knowledge can be gleaned
from clinical studies conducted from the 1950s to
the early 1970s, it is necessary to conduct modern
investigations utilizing state-of-the-art research
methodologies in order to definitively establish
17 Use of the Classic Hallucinogen Psilocybin for Treatment of Existential…
the safety and efficacy of this novel treatment. To
date, contemporary studies conducted at three
academic medical centers are producing positive
results. While still preliminary, these encourag-
ing reports will hopefully facilitate the
development of additional investigations with the
hallucinogen treatment model, particularly in
patient populations refractory to conventional
therapeutic approaches [28].
A unique aspect of utilizing a classic hall-
ucinogen (e.g., psilocybin) to treat the severe
psychological demoralization and existential
anxiety seen in life-threatening medical illness is
its seeming capacity to facilitate powerful states
of spiritual transcendence that exert in the patient
a profound therapeutic impact with often dra-
matic improvements in psychological well-being.
Recently conducted research at Johns Hopkins
University has demonstrated that, under carefully
structured conditions in normal volunteer sub-
jects, induction of such transcendent and mysti-
cal states of consciousness occurs in most subjects
studied. This is a critical advancement in the field
because, for the first time, a specific treatment
has been developed that is able to reliably facili-
tate the emergence of a transpersonal level of
consciousness that appears to have significant
therapeutic value. For a patient population strug-
gling with often overwhelming levels of existen-
tial anxiety and demoralization, such a therapeutic
intervention may have the capacity to reinfuse a
sense of meaning and purpose into their lives.
The hallucinogen treatment model therefore
offers a novel and potentially valuable approach
for addressing the existential crisis often
observed in cancer patients, with the potential of
significantly improving overall quality of life and
psychospiritual well-being for the time that
remains in their lives.
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